Article
Australian Journal of Herbal Medicine 2014 26(2)
Characteristics of the Australian complementary and alternative medicine (CAM) workforce Matthew J Leach1, Erica McIntyre2, Jane Frawley3 School of Nursing & Midwifery, Sansom Institute for Health Research, University of South Australia, North Terrace, Adelaide, South Australia 5000, Australia 2 School of Psychology, National Wine and Grape Industry Centre, Charles Sturt University, Wagga Wagga, NSW 2650, Australia 3 Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia 1
Correspondence: Dr Matthew J Leach School of Nursing & Midwifery Sansom Institute for Health Research University of South Australia North Terrace, Adelaide, SA 5000, Australia Tel: (08) 8302 2846 Fax: (08) 8302 2168 Email:
[email protected]
Abstract Background/aim: The complementary and alternative medicine (CAM) workforce is the third largest occupational group in the Australian health sector. Yet the profile of this workforce is not well understood. This study aims to provide new insight into the Australian CAM workforce by exploring the demographic and practice characteristics of this occupational group. Methodology: Members of the National Herbalists Association of Australia (NHAA) were invited to participate in a descriptive, online survey. The NHAA, comprising of 1,125 members, is a professional association representing both Western herbalists and naturopaths, although nearly half of members primarily practice in another CAM discipline. The 82-item survey consisted of demographic questions (e.g. gender, age, highest qualification, place of residence, location of business), questions related to CAM practice (e.g. main occupation practiced, years in practice, employment type, number of clients consulted per week, fees charged and annual taxable income for practice), and questions relating to NHAA membership. Results: A response rate of 35.4% (n=399) was obtained. Participants were primarily female (86.7%), aged between 41-60 years (56.1%) and resided in a major city (61.7%). The majority of respondents (37.1%) held an undergraduate degree as their highest qualification, with 34.6% holding a postgraduate qualification and 27.6% holding an advanced diploma or lower-level qualification. Respondents most commonly practiced naturopathy (61.6%), herbal medicine (51.9%), nutrition (15.2%), massage therapy (14.4%) or another discipline (20.2%), with the majority of participants being in practice in their main modality for less than 10 years (47.6%). The number of years in practice, initial consultation fee and employment type were found to be statistically significantly associated with a higher income from clinical practice (p 60
49 (12.3)
State/Territory of Australia NSW
152 (38.1)
VIC
113 (28.3)
QLD
63 (15.8)
WA
28 (7.0)
SA
17 (4.3)
TAS
11 (2.8)
Overseas
9 (2.3)
ACT
4 (1.0)
NT
2 (0.5)
RA Class [residential location] Major City
246 (61.7)
Inner Regional
62 (15.5)
Outer Regional/Remote
91 (22.8)
RA = Remoteness Area, according to the Department of Health (2014)
ordinal, a nonparametric method of analysis was used. Frequency distributions and percentages were used to describe the data. Pearson chi-square test of contingency (α = 0.05) was used to assess the strength of the relationship between: gross income and practitioner age, highest qualification, area of residence, years in practice, employment type and employment status; and between age, gender and type of employment. Cramer’s V was used to determine the effect size of all relationships between variables. Ethics The survey was initially undertaken by the NHAA for internal purposes. The research team (authors) approached the NHAA seeking permission to analyse the de-identified data, with permission granted by the NHAA board of directors.
Results A total of 399 NHAA members completed the survey, providing a response rate of 35.4%. 60
3 (0.8)
Primary occupation (n = 362) Naturopath
223 (61.6)*
Herbalist
188 (51.9)*
Other
73 (20.2)*
Nutritionist
55 (15.2)*
Massage therapist
52 (14.4)*
Homoeopath
21 (5.8)*
Nurse
19 (5.2)*
Researcher
11 (3.0)*
Industry
9 (2.5)*
Traditional Chinese medicine
8 (2.2)*
General practitioner
5 (1.4)*
Pharmacist
4 (1.1)*
Chiropractor
1 (0.3)*
Osteopath
1 (0.3)*
Years working in primary occupation (n = 362) < 1 year
30 (8.3)
1 to 5 years
85 (23.5)
6 to 10 years
75 (20.7)
11 to 15 years
53 (14.6)
16 to 20 years
29 (8.0)
> 20 years
52 (14.4)
Not in clinical practice
38 (10.5)
*Multiple responses, with percentages listed as the percentage of cases.
Demographic characteristics The majority of participants were female (86.7%), and most (61.7%) lived in a major city. New South Wales had the highest number of respondents (38.1%), with the least residing in the Northern Territory (0.5%). Participants were most commonly aged between 51-60 years (28.3%), although a similar proportion were aged between 41-50 years (27.8%) and 31-40 years (24.6%) (Table 1). Professional characteristics Most respondents (37.1%) held an undergraduate degree as their highest qualification, with a total of 34.6% holding a postgraduate qualification. Less than one-third of participants (27.6%) possessed a qualification at or © NHAA 2014
Article
Australian Journal of Herbal Medicine 2014 26(2)
Table 3: Practice characteristics of participants n (%) Clinic location [RA class] (n = 297)
n (%) Initial consultation fee [AU$] (n = 288)
#
#
Major City
188 (63.3)
< 100
164 (56.9)
Inner Regional
53 (17.8)
101–150
106 (36.8)
Outer Regional/Remote
56 (18.9)
151–200
12 (4.2)
> 200
6 (2.1)
GTI from clinical practice [AU$] (n = 298)
#
< 25,000
165 (55.4)
Follow-up consultation fee [AU$] (n = 288)#
25,001 - 50,000
67 (22.5)
< 100
50,001 - 75,000
34 (11.4)
101–150
27 (9.4)
> 75,000
32 (10.7)
151–250
2 (0.7)
Employment type (n = 362)
259 (89.9)
Length of initial consultation [minutes] (n = 290)#
Full-time
99 (27.3)
< 45
Part-time
185 (51.1)
46–60
121 (41.7)
Casual
78 (21.5)
61–75
93 (32.1)
76–90
46 (15.9)
> 90
15 (5.2)
Employment status (n = 332) Self-employed
291 (87.7)
15 (5.2)
Employed (paid wage)
33 (9.9)
Length of follow-up consultation [minutes] (n = 290)#
Retired
8 (2.4)
< 15
4 (1.4)
Number of consultations per week (n = 290)#
16–30
98 (33.8)
60
> 15
11 (3.8)
Type of consultations (n = 295)
9 (3.1) #
Hours worked per week [part-time/casual only] (n = 261)#
Face-to-face
294 (99.7)*
< 10
110 (42.1)
Skype/Phone
70 (23.7)*
11–20
87 (33.3)
Email/online
42 (14.2)*
21–30
47 (18)
> 30
17 (6.5)
GTI = Gross Taxable Income. RA = Remoteness Area, according to the Department of Health (2014). #Participants not in clinical practice were excluded.
below the level of advanced diploma. The most frequently reported practice disciplines were naturopathy (61.6%), herbalism (51.9%), nutrition (15.2), massage therapy (14.4%) and other (20.2%); noting that participants could select more than one main occupation for this question. More than half (55.4%) of all respondents identified as having multiple professions. The majority of participants were in practice in their primary profession for 1-10 years (44.2%) (Table 2). Practice characteristics More than half of participants had a clinical practice in a major city (63.3%), worked part-time (51.1%) and were self-employed (87.7%). Most practitioners who worked part-time or casually (42.1%) spent less than 10 hours in clinical practice per week (Table 3). The majority of respondents in clinical practice (55.4%) earned less than $25,000 of gross taxable income per annum. The majority of practitioners (78.3%) conducted less than five consultations per week on average. Consultations were primarily delivered face-to-face (99.7%), with few © NHAA 2014
*Multiple responses, with percentages listed as the percentage of cases.
practitioners (14.2%) also delivering consultations by email or online. Most practitioners (56.9%) charged less than $100 for an initial consultation, and spent between 46 and 60 minutes completing the initial consult (41.7%). Likewise, most practitioners (89.9%) charged less than $100 for a follow-up appointment, spending between 31 and 45 minutes for this consult (37.9%). However, almost as many practitioners (33.8%) spent between 16 and 30 minutes in a follow-up consultation (Table 3). Relationship with gross taxable income Years in primary occupation (χ2 = 76.59, p